Comparing once-weekly semaglutide to incretin-based therapies in patients with type 2 diabetes: a systematic review and meta-analysis

Sep 24, 2018Diabetes & metabolism

Once-weekly semaglutide compared to other incretin-based treatments in type 2 diabetes

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Abstract

Once-weekly semaglutide resulted in a greater reduction in haemoglobin A1c compared to other incretin-based therapies.

Semaglutide led to a reduction in haemoglobin A1c by -0.38% compared to other GLP-1 receptor agonists and -1.14% compared to DPP-4 inhibitors.
Patients on semaglutide experienced a weight loss of -2.50 kg compared to other GLP-1 receptor agonists and -3.19 kg compared to DPP-4 inhibitors.
A higher proportion of patients achieved glycaemic goals and target weight loss while on semaglutide than those on other incretin-based therapies.
Semaglutide treatment was associated with a significantly higher incidence of gastrointestinal side effects.

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AIMS: Our aim was to compare once-weekly semaglutide to incretin-based therapies - defined as either dipeptidyl peptidase-4 inhibitors (DPP-4i) or other glucagon-like peptide-1 receptor agonist (GLP-1RA) - in patients with type 2 diabetes.

METHODS: We searched for randomized trials comparing once-weekly semaglutide to other incretin-based therapies in patients with type 2 diabetes. We pooled trials that compared semaglutide to other GLP-1RA together, and those comparing semaglutide to DPP-4i together. The primary outcome was the change in haemoglobin Aover time. 1c

RESULTS: Five trials met our inclusion criteria. There was a significantly greater reduction in haemoglobin Afavouring semaglutide when compared to other GLP-1RA or DPP-4i [MD (95% CI) = -0.38% (-0.62, -0.15) and -1.14% (-1.53, -0.75) respectively]. There was a significantly greater weight loss favouring semaglutide when compared to other GLP-1RA or DPP-4i [MD (95% CI) = -2.50 kg (-3.91, -1.09) and -3.19 kg (-3.66, -2.72) respectively]. The proportion of patients achieving glycaemic goals and goal weight loss was greater in semaglutide-treated patients when compared to either other GLP-1RA or DPP-4i. However, semaglutide-treated patients had a significantly higher incidence of gastrointestinal side effects. 1c

CONCLUSIONS: While both once-weekly semaglutide and other incretin-based therapies can reduce haemoglobin A, semaglutide causes a more potent haemoglobin Areduction and greater weight loss when compared to other incretin-based therapies. However, this potent effect of semaglutide was associated with a higher incidence of gastrointestinal side effects. Additional studies are needed to determine whether this marked reduction in both haemoglobin Aand body weight may translate into improved cardiovascular outcomes. 1c1c1c

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Comparing once-weekly semaglutide to incretin-based therapies in patients with type 2 diabetes: a systematic review and meta-analysis

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